Pain Management Class Packs a Punch

A new study suggests a single 2-hour session of a pain management skills class could offer as much benefit as 8 sessions of cognitive behavioral therapy (CBT) for patients experiencing chronic low-back pain (CLBP).

Supported by NCCIH and NIDA, the study—published in JAMA Network Open—explored whether a compressed intervention could lead to the same benefits as a longer course of CBT. 

There’s an increase in the use of surgery and medications to manage CLBP—the most common source of chronic pain worldwide—though growing evidence has led to pain education and CBT being recommended as first-line treatments.

The research team at Stanford University recruited 263 adults who had experienced CLBP for at least 6 months. The 87 patients randomized to the empowered relief group participated in a single, 2-hour pain relief skill-building class that incorporated pain education, mindfulness principles and such self-regulatory skills as relaxation, cognitive reframing and self-soothing. The 88 patients in the CBT group participated in eight 2-hour classes in pain management education and active cognitive behavioral skill-building. Within the health education group, 88 patients participated in a single 2-hour class about back health.

In the study, the primary outcome was measured in differences in the Pain Catastrophizing Score using a scale that evaluates 13 cognitive and emotional responses to pain. Pain catastrophizing can lead to increased attention to pain and feelings of helplessness or loss of control, which can prompt neural circuits in the brain to amplify pain signals. 

When comparing Pain Catastrophizing Scale scores at 3 months after intervention, outcomes in the empowered relief group were on par with the CBT group, while researchers found that both CBT and empowered relief were superior to the health education session.

“CBT delivered in groups can offer important elements like contact with a therapist and peer support,” said NCCIH director Dr. Helene Langevin. “But we realize that 16 hours of treatment time and the associated costs could be out of reach for some patients, so this research could expand treatment options and make nonsurgical and nonpharmaceutical pain management accessible to more patients.”